Yakima Valley Farm Workers Clinic: Carlos Olivares, Executive Director

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With a small grant from the federal government, The Yakima Valley Farm Workers Clinic was founded 30 years ago to care for migrant and seasonal farm workers. The small clinic in Toppenish, Washington had one physician on staff. The Toppenish clinic today has 44 medical exam rooms and a dental clinic. It continues to serve seasonal and migrant farm workers, but also targets low income populations, the underinsured, and uninsured.

Expanding Services to Meet Demand

Executive Director, Carlos Olivares, came to the clinic about five years after it opened. “The lack of services— medical, dental, and social services for this community—was significant,” he says. “As demand for healthcare services was identified, we began to move into a different type of strategic plan that really looked at expansion of services to meet demand.”

The Yakima Valley Farm Workers Clinic is now a 120 million dollar operation that relies on government funding for less than 7% of its total revenue. Last year the organization served 135,000 people and produced over a half-million face-to-face visits with a provider for medical and dental services. The group employs 1,400 people in clinics in the states of Washington and Oregon and has a medical staff of more than 200 physicians and 39 dental providers.

“We now provide a full complement of services for all of our patients starting with medical care—primary care—but also some specialty care built around OB, pediatrics and internal medicine. We also have a pharmacy, fully automated, in most of our 17 clinics,” says Olivares.

Yakima Valley operates the largest Women, Infants, and Children (WIC) program in the state of Oregon where they serve 9,000 families. In Washington they serve more than 10,000. “We have community service programs associated with diabetes, asthma, and the highest immunization rate,” says Olivares. “90% of our children are fully immunized.”

They also own approximately a third of one of the largest Medicaid managed care plans in the area. “We have been in the managed care world now for almost fifteen years and we have over 40,000 enrollees. We have expanded our work around other types of social services. We have a community action program that has a budget of over $10 million and we do a lot of educational programs with youth in the school districts. We do a weatherization and energy assistance program. We are very much moving into the full implementation of a medical home model that I hope will be viewed as one of the most innovative models in the country,” says Olivares.

A Business Approach to the Delivery of Healthcare

“A couple of things have become clear over the years,” says Olivares. “The automating functions do not always represent a savings in cost. Much of the time, the investment in technology is not a short term gain, but it’s always a long term gain.”

Yakima Valley already has a fully electronic medical records system, including dental, as well as a robotics system built into their pharmacies. “We have an IT intelligence program that allows us to produce information and data and, in turn, allow us to make decisions based on solid information,” Olivares says. “I believe that we are probably set better than most organizations for welcoming the new healthcare reform.”

He emphasizes the importance of hiring people who are extremely competent in their fields. Most of his management team has been with him for almost 15 years. As new services are added, such as information technology, he has added experts to take care of those areas of the business. “My philosophy on hiring managers is that you’ve got to have people who have experience and are capable of doing the work. They have to be smarter than I am,” he says. “And they have to have the work ethic that I have.”

“We have an incredible work force and I assure you, every one of my employees knows me. I visit all of our clinics on a regular basis. I put over 40,000 miles a year on my car because I am engaged and I demand my managers to be engaged. I think an aspect of our structure is we make decisions based on data and we make decisions based on solid information. We try to stay away from the hypothetical decisions. Those are usually not lasting.”

“We function very much as a business, and as a business with a heart,” says Olivares. “It is important to keep the mission of our organization in place. Migrant and seasonal farm workers continue to be our priority. Low income and underserved people continue to be the driver of everything we do. However, we believe that you can merge that philosophy with one of responsible business strategies that allow you to be progressive, sustainable, and at the same time, continue that special commitment to the population we serve.”

“There’s usually this sense that if you are a non-profit organization, business principles are not very compatible with your mission. I think over the last 20 years we have proven that to be a wrong assessment and a wrong statement to make.”

-by T.M. Simmons

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